School ID : 108123

School Name : KAONG ELEMENTARY SCHOOL

E-mail Address : depedcavite.kaonges@gmail.com
Contact Number : 09684922020
Date : September 22, 2022

Form 2. CHANGE REQUEST FORM

(ENROLMENT WITH GAP / ENROLMENT OF INELIGIBLE / CORRECTION OF GRADE LEVEL)
Instructions: 1. Fill up the LRN and the necessary details in the Learner's Name Columns.
2.Indicate the appropriate level (Elementary or Secondary) of the learner.

1
For Proof of Grade Level:
Present a photocopy of any of the following per learner:
- SF10 (Last School Year Attended) - PEPT Result
- SF9 (Last School Year Attended) - Notarized Affidavit of Undertaking
- Certificate of Completion (Last Grade Level Completed) - A&E Result

Legend in Remarks Column:

A = Approved DA = Disapproved NLR = No LIS Request INC(NPGL) - Incomplete Attachment (No / Wrong Proof of Grade Level)

Proof of To be filled up by
Learner's Name Level
Grade Division Personnel
LRN (Elem /
Extension
Last name First Name Middle Name Secondary) Level 1 Remarks
Name
108305170070 BRAZAL DEEJHAY ARADO Elementary

108123170090 RODRIGUEZ ANGELO BASILAN Elementary

108123170081 FURIO JENNY Elementary

Requested by: Processed by:

Document Reference Code:

DOC-PAR-FR-003
Revision No.:
Rev.04
 JENIFER M. SOTTO
Signature over Printed Name Planning & Research Unit
School Representative

To be filled up by
Learner's Name Level Proof of
Division Personnel
LRN (Elem / Grade
Extension
Last name First Name Middle Name Secondary) Level 1 Status
Name

Requested by: Processed by:

Document Reference Code:
DOC-PAR-FR-003
Revision No.:
Rev.04
 JENIFER M. SOTTO
Signature over Printed Name Planning & Research Unit
School Representative

Document Reference Code:

DOC-PAR-FR-003
Revision No.:
Rev.04